MEDICARE: SAMUEL JOHN OHLANDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	036140550	IL

General Provider Information

NPI Number	:	1043452287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL JOHN OHLANDER M.D.

Provider Business Mailing Address
First Line	:	820 S WOOD ST
Second Line	:	CLINICAL SCIENCES NORTH, SUITE 515
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3747
Country	:	US
Telephone Number	:	312-996-2779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	12/07/2023

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